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Anxiety Disorders

This article explores the commonalities and symptoms of anxiety disorders, with a specific focus on Post-Traumatic Stress Disorder (PTSD). It discusses the role of fear, avoidance, and functional impairment in these disorders, as well as effective cognitive-behavioral therapy (CBT) methods for treatment.

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Anxiety Disorders

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  1. Anxiety Disorders Monica Basco, Ph.D. Clinical Psychologist University of Texas at Arlington Department of Psychology

  2. What they have in common • Fear • Avoidance • Target • Functional Impairment

  3. Fear Stimulated by: • Events: • Reminders of the event, memories • Thoughts: • Catastrophizing • Magnification • Fortune Telling • Personalization • Worry and Rumination

  4. Avoidance • Use avoidance to lessen fear • Avoidance is reinforced as a coping strategy

  5. Target • Recent traumatic event • Past traumatic event

  6. Functional Impairment • Insomnia • Difficulty concentrating • Withdrawal • Decreased social support

  7. Post-Traumatic Stress Disorder

  8. PTSD • Originally diagnosed in combat veterans • Shell Shock in WWII • Expanded to include other types of trauma • Experience of terror or horror • Life threatening situations • Risk of bodily injury • Observer or victim

  9. PTSD • War • Fire • Assault • Rape • Child abuse • Natural disasters • Explosions • Terrorist attacks

  10. PTSD • Many symptoms needed for diagnosis • Avoids false memory syndrome • Can fluctuate in intensity over time

  11. PTSD • Exposed to trauma • Response was intense fear, horror, and/or helplessness • Trauma is re-experienced • intrusive memories • bad dreams • Emotionally reliving the experience • Distress when exposed to cues and physiological reactivity

  12. PTSDAvoidance • Avoidance of reminders • Numbing of general responsiveness • Avoids thoughts, feelings and conversations about it • Avoid activities, places and people

  13. PTSDAvoidance • Has forgotten important details • Decreased interest and activity • Detachment from others • Decreased range of affect • Sense of foreshortened future

  14. PTSDIncreased Arousal • Initial or middle insomnia • Irritability or angry outbursts • Poor Concentration • Hyper-vigilance • Exaggerated startle

  15. PTSD • More than 1 month • Clinically significant distress or impairment • Acute-less than 3 months • Chronic-more than 3 months • Delayed onset

  16. Coping with Thoughts about trauma • Cognitive triad • Evaluating the meaning of the event • Automatic Thoughts • Schemas

  17. Cognitive Triad • Were schemas changed by the event? • What does the trauma mean about • Self • Others • Future

  18. Automatic thoughts about recent traumas • When there are reminders of the trauma, what ATs are stimulated? • Are there any distortions? • Feelings? Are they prolonged? • Actions? Any coping errors?

  19. Goals of CBT for PTSD • Symptom Reduction • Control Dysfunctional Thoughts • Teach Effective Anxiety Reduction Techniques • Teach Coping Skills

  20. CBT Methods for PTSD • Stress Inoculation Training • Relaxation Training • Thought Stopping • Cognitive Restructuring • Positive Self-Statements • Problem-solving Skills

  21. Relaxation Training • Controlled Breathing • Focused Breathing Technique • Progressive Muscle Relaxation • Imagery

  22. Differential Relaxation • Learn standard relaxation induction • Practice maintaining relaxed state while involved in tasks • Practice in non-threatening situations • Practice alone with graded in-vivo exposure

  23. Thought Stopping for Obsessive and Intrusive thoughts • Recognition • Breathing • Stop image • Switch Imagery • Repeat if needed

  24. Cognitive Restructuring • Exam the Evidence • Generate Alternative Explanations • Perspective Taking • Socratic Questioning • Advantages and Disadvantages

  25. Positive Self-Statements • Coping Cards • TIC TOC

  26. Problem Solving • Define the problem in concrete terms • Generate possible solutions without editing • Select a solution • Implement the plan • Evaluate the outcome

  27. CBT Methodsfor PTSD • Prolonged Exposure • Information Gathering • Construct Desensitization Hierarchy • Imaginal exposure • In vivo exposure

  28. Exposure • Imaginal • reliving the traumatic event in session • tape recording reviewed at home • In Vivo • Desensitization hierarchy developed

  29. Imaginal Exposure • Identify stressful stimuli • Plan strategy for coping with the event • Role play in session • Utilize anxiety reduction strategies • Cognitive rehearsal

  30. In-vivo Exposure • Construct desensitization hierarchy • Choose an easy starting place • Plan coping strategy • Troubleshoot • Assign as Homework • Follow-up and Repeat

  31. Behavioral Rehearsal • Target Stressful Situations • Plan Coping Strategy • Practice Strategy in Session • Assign as Homework • Review and Modify

  32. Coping Strategies • Manage anxiety • Assertiveness with others • Implement problem solving plan • Avoid avoidance

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